Feasibility and Success of Muscular Ventricular Septal Defect Occluders and Mushroom-Shaped Occluders in Transcatheter Patent Ductus Arteriosus Closure in Low-Weight Children: A Propensity Score-Matched Retrospective Analysis from a Chinese National Regional Health Center.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiology Pub Date : 2024-08-01 DOI:10.1159/000540685

Kaijun Zhang, Le Yang, Rensen Zhang, Jingdong Ma, Min Cheng, Penghui Yang, Ping Xiang, Mi Li, Xue Zhou

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Abstract

Introduction: Muscular ventricular septal defect occluders (MVSDOs) have been attempted as an option in low-weight patients with patent ductus arteriosus (PDA). However, few studies have assessed the safety of transcatheter patent ductus arteriosus closure (TCPC) using MVSDO. Therefore, we compared the outcomes in low-weight patients who used MVSDO and mushroom-shaped occluder (MSO).

Methods: Medical records of children under 10 kg (n = 417) who underwent TCPC from 2015 to 2021 at a Chinese health center were reviewed. They were divided into MSO (n = 372) and MVSDO (n = 45) groups. A 1:1 propensity score matching (PSM) was done considering gender, height, weight, body surface area (BSA), PDA diameter, and BSA-corrected PDA diameter.

Results: All 45 children in the MVSDO group (mean weight: 5.92 ± 1.32 kg) achieved successful immediate occlusion. One case in the MVSDO group experienced device migration within 24 h requiring unplanned surgery. MVSDO significantly ameliorated pulmonary artery hypertension. After PSM, each group comprised 41 children. The MVSDO group had a smaller effect on platelet counts (MVSDO vs. MSO = 259.85 ± 114.82 vs. 356.12 ± 134.37, p < 0.001), a reduced incidence of thrombocytopenia (MVSDO vs. MSO = 2/41 vs. 7/41, p = 0.001), and a higher rate of residual shunting (MVSDO vs. MSO = 16/41 vs. 5/41, p = 0.005), compared with the MSO group. Thrombocytopenia resolved during hospitalization and micro-shunts disappeared by 6 months. No pulmonary artery or descending aortic secondary stenosis was observed in 1-year follow-up.

Conclusions: MVSDO used in low-weight children is feasible, with high success and satisfactory postoperative and short-term follow-up outcomes, including lower thrombocytopenia incidence, compared to MSO. Further long-term studies with larger samples are recommended.

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肌肉型室间隔缺损封堵器和蘑菇状封堵器在低体重儿童经导管动脉导管未闭中的可行性和成功率：一项来自中国国家区域医疗中心的倾向得分匹配回顾性分析。

导言：肌肉型室间隔缺损封堵器（MVSDO）已被尝试作为动脉导管未闭（PDA）低体重患者的一种选择。很少有研究评估了使用 MVSDO 进行经导管动脉导管未闭（TCPC）的安全性。因此，我们比较了使用 MVSDO 和蘑菇状闭塞器（MSO）的低体重患者的治疗效果：方法：我们回顾了 2015 年至 2021 年在一家中国医疗中心接受 TCPC 的 10 公斤以下儿童（n=417）的病历。他们被分为 MSO 组（n=372）和 MVSDO 组（n=45）。考虑到性别、身高、体重、体表面积（BSA）、PDA直径和BSA校正后的PDA直径，进行了1:1倾向得分匹配（PSM）：MVSDO 组的所有 45 名患儿（平均体重：5.92 ± 1.32 千克）都成功实现了即刻闭塞。一名 MVSDO 在 24 小时内移位，需要进行计划外手术。MVSDO 明显改善了肺动脉高压。PSM 后，每组有 41 名儿童。与 MSO 组相比，MVSDO 组对血小板计数的影响较小（MVSDO vs. MSO =259.85 ± 114.82 vs. 356.12 ± 134.37，p = 0.001），血小板减少的发生率较低（MVSDO vs. MSO = 2 vs. 7，p = 0.001），残余分流率较高（MVSDO vs. MSO =16/41 vs. 5/41，p = 0.005）。血小板减少症在住院期间得到缓解，微分流在六个月前消失。随访一年未发现肺动脉或降主动脉继发性狭窄：与 MSO 相比，在低体重儿童中使用 MVSDO 是可行的，成功率高，术后和短期随访结果令人满意，包括血小板减少发生率较低。建议进行更大规模的长期研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiology 医学-心血管系统

CiteScore

3.40

自引率

5.30%

发文量

审稿时长

1.5 months

期刊介绍： ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.